Obesity is a major U.S. public health epidemic. A review of the current literature identified a lack of obesity counseling with individuals. The gap in practice was a lack of understanding of nutrition, nutrition labeling, and how foods affect health. The objective of this project was to identify the community assessment need related to obesity and then educate APRNs on ways to better communicate with obese patients. This project focused on an education program for advanced practice registered nurses (APRNs) on using the 5 A's framework for obesity counseling to improve their knowledge and skill in counseling their overweight and obese patients in a rural primary care clinic. Knowles' adult learning theory was used to develop the education project. The education program was presented to and evaluated by 2 APRNs at a rural health clinic. The providers requested the information be placed online so they could give the presentation their undivided attention. The audio-based PowerPoint presentation and printed copies of the presentation content were e-mailed to each of the providers. The presenter went to the clinic 3 days after placing the presentation online to obtain the evaluations and answer any questions. An impact evaluation assessed the presenter, audience learning experience, and confidence and skill of the participant. The participants reported they had a better understanding of the reality of the obese population and how they could improve their communication by using the 5 A's method of assessment. Both participants reported the presentation was clear and easy to understand. A recommendation was made to conduct a future quality improvement project expanding the use of the educational program. This project has the potential to impact social change by improving health care education and ultimately reducing obesity.

Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase in nonadherence to treatment plans, decreased health stature, increased comorbidities, and an increase in utilization of emergency room and acute care resources. A prior study of 140 randomized adult diabetic patients was the basis for the need of this project. Designed as a staff development in-service to educate nursing and the care provider team, this program integrated health literacy and therapeutic communication techniques into diabetic care. Using the health literate care model universal precautions approach, the project began as a pilot at one of the FQHC's clinical sites by assessing all patients for health literacy using the Newest Vital Sign screening tool. Staff were instructed on the validity of using health literate therapeutic communications as a bridge to adherence to diabetic treatment regimens. The project has potential to improve the overall health and promote positive social change in the rural community.

Thesis (M.ED (Continuing care and Training)) --University of Limpopo, 2010. / This report describes the research conducted at Phuthanang Home Based Care in Mankweng Township in the Limpopo Province of South Africa. Mankweng constitute a mixture of both formal and informal settlements, both urban and rural settlements and is situated about 32 km to the east of Polokwane which is the provincial capital for Limpopo. The aim of the research was to investigate the challenges faced by Phuthanang Home Based Care (HBC) in providing care and training in Mankweng Township. Having established the challenges faced by Phuthanang Home Based Care the researcher intended to recommend possible solutions to these problems. In an attempt to meet the above mentioned aims; the following research questions were formulated: Main question: • What are the challenges faced by Phuthanang Home Based Care in providing care and training? The following sub questions were asked derived from the main question above: • What are the aims and objectives of Phuthanang Home Based Care? • What are the existing services and training programmes offered by caregivers at Phuthanang Home Based Care? • What are the experiences of caregivers in relation to training for Home Based Care? • What is the level of community participation in Phuthanang Home Based Care activities? Chapter two outlines the theoretical framework based on relevant literature on the subject under study. I also formulated assumptions about the challenges that could be facing home based care programmes; these include issues such as lack of funds, inadequate training and stigmatisation among others. In this chapter key concepts were defined and operationalised to suit this research and to avoid ambiguity in interpretation. Chapter three outlines the research methodology. It clearly explains the research design used, data collection and data analysis. This study was purely qualitative and took the form of a single case study design. This enabled a detailed and intensive study of the case as it exists in its natural setting. Data was collected according to two streams which are fieldwork and document analysis. In fieldwork the researcher used multiple data collection techniques which include open ended interviews with the Project Coordinator, Administrator and Caregivers. The other technique used was observations. A focus group interview with the Coordinator, Administrator and four caregivers was also employed during fieldwork. A data matrix was used in the analysis of data. Chapter four constitutes the presentation and analysis of findings of the study. In this chapter; I describe the setting of the organisation in terms of location, historical background as well as its aims and services rendered. It outlines the challenges encountered by Phuthanang Home Based Care in providing care and training based on the results from document analysis, interviews, observations and focus group interview with the Caregivers’, the Administrator and the Coordinator of Phuthanang Home Based Care. The findings will suggest recommendations that will help bolster the state of care giving, training, and improve the way care is rendered to people living with HIV/AIDS and other terminal illness. Chapter five presents my conclusions by outlining the challenges faced by Phuthanang Home Based Care in providing care and training. This chapter also presents recommendations that might contribute towards finding solutions to the problems faced by Phuthanang Home Based Care. After the recommendations I presented a section on reflections of the research process. In conclusion to this chapter I recommend further research on the challenges faced by home based care organisations which have an element of training in poor communities such as townships, informal settlements and rural areas.

Thesis (M.Dev.) --University of Limpopo, 2010 / Living in informal settlements is associated, theoretically, with the exposure and vulnerability to Brown Environmental Problems. Literature further stresses the association of informal settlements and poor living conditions by demonstrating that the establishment of informal settlements around the cities is intricately associated with poor living conditions that enforce circumstances of perpetual risk and high levels of vulnerability to Brown Environmental Problems. Overcrowding, poor service provision and heavy reliance on dirty fuels characterizes informal settlements and therefore link these settlements and environmental risks and hazards. The link between informal settlements and environmental risks and hazards is in return making people who live in these settlements vulnerable to, among other things, the Brown Environmental Problems, such as indoor pollution, dirty water, poor sanitation and poor waste management. It therefore became increasingly necessary to investigate the vulnerability to Brown Environmental Problems associated within these settlements. The investigation was done in Seshego, Zone 6, mostly known as Shushumela (Rainbow-Park). The study adopted a combination of the qualitative and quantitative approaches. The qualitative approach was used to describe the characteristics of the informal settlement, the types and origins of the Brown Environmental Problems, the living conditions within the settlement, and to detail the individual accounts of the informal settlements population’s opinions and experiences on their vulnerability. Additionally, quantitative approach was used to measure the demographic profile of the households within the settlements, to determine the population density in the settlements, the frequency of the households’ exposure to a variety of Brown Environmental Problems and the amount of time of exposure to dirty fuels, dirty water, and poor sanitation. The prevalence rate of the different types of the Brown Environmental Problems was also quantitatively constructed. The study compiled its conceptual framework by digesting and synthesising contributions from the system of ideas that involves the general assumption about the relationship between informal settlements living conditions and vulnerability of the populations therein to Brown Environmental Problems. Zone 6 is an informal settlement in Seshego, this settlement is also known as Rainbow Park-Shushumela. Like other informal settlements, Shushumela comprises of people who need a place to stay but unable to find one due to various reasons one of them being affordability issue. Shushumela informal settlement does not have basic services. Its residents stay in shacks and use their own ways to survive the situation of living without electricity, adequate sanitation and waste removal services. The residents are exposed to various Brown Environmental Problems such as indoor air pollution due the use of paraffin wood and coal, waterborne diseases and sanitation-borne diseases due to the limited access of water and use of pit latrines. The residents’ overall living conditions expose them to Brown Environmental Problems.

Background: While there has been a dramatic increase in the prevalence of diabetes in developing countries, such as Mexico, there is a critical need to better understand how the challenges that arise in shifting the focus from acute care to care for chronic conditions manifest at the level of patient care provision in the health care organization and community, especially in rural resource-poor communities. One step in this direction is the exploration of the potential that social capital may provide in improving our understanding of the relationships that exists among patients, health care providers and the broader community. Objectives: To examine the provision of health care for diabetes, as well as the beliefs, resources and relationships that exist among patients and families, health care teams and community partners that affect treatment for diabetes in a rural resource-poor community in Mexico. Methods: This study incorporated a qualitative action-research approach and data was collected via community asset mapping, surveys, semi-structured interviews and group discussions. Utilizing an action research model, the study procedures were iterative, whereby results from selected data collection techniques were used to inform subsequent iterations of data collection. Community resources were identified with key informant input and via community exploration, to record existing and potential diabetes-related resources. Surveys were administered to health care providers, patients and general community members. Semi-structured interviews and group discussion topics were informed by the Innovative Care for Chronic Conditions Framework as well as by prior data collection procedures such as the surveys and preceding interviews. The interviews and group discussions were conducted with health care providers, diabetic patients, and community leaders. Results: Community asset mapping revealed limited existence of health care resources available to the rural community in Mexico. Three salient themes emerged across health care providers, diabetic patients, and community leaders: (1) Cultural eating behaviors are important drivers in preventing and managing diabetes mellitus; (2) Diabetic patients are currently ill-prepared to adequately manage chronic conditions, such as chronic conditions; (3) Trust is an important facilitator and/or barrier for both patients and health care providers when searching for ways to enhance management of diabetes outside of the health care organization. Conclusion: An evidence-based understanding of the diabetes-related beliefs, current perceived performance of diabetes care provision, the availability of community resources and social capital can be used to leverage the health care in low-income communities where primary health services are limited in their availability and/or capacity. The informed construction of community-derived initiatives and interventions that integrate community resources and improve the social capital within the community can enhance the care for patients with diabetes by offering both alternative and complementary avenues of accessing care that supports long-term disease management.

Chapter II describes results from 197 rural households that were sampled over five continuous days for indoor and outdoor PM10, PM2.5, and endotoxin. Geometric mean indoor concentrations of PM10 and PM2.5 (21.2 πg m-3, 12.2 πg m-3) were larger than outdoor concentrations (19.6 πg m-3, 8.2 πg m-3; p =0.072, p<0.001). While geometric mean endotoxin levels were almost six times larger in outdoor air compared to indoor (1.47 EU m-3, 0.23 EU m-3; p <0.001). Airborne PM10 and endotoxin concentrations in a rural county were elevated compared to those previously reported in certain urban areas. Furthermore, during the harvest season, concentrations of endotoxin in ambient air approached levels that have been shown to cause decreased respiratory function in occupational workers. Chapter III evaluated the effectiveness of using Radiello passive monitors to measure hydrogen sulfide (H2S) in close proximity (<40 m) to a medium sized CAFO. A total of eight passive H2S monitors were deployed 7-14 days around a swine confinement for seven months. Additionally, a separate laboratory study was carried out to determine the monitor's H2S uptake rate. Concentrations of H2S measured near the confinement were varied and ranged from 0.6 to 95 ppb depending on the sampling period and proximity to the lagoon .The uptake rate provided by the supplier (0.096 ng ppb-1 min-1) was significantly larger (p=0.002) than the rate determined experimentally (0.062 ng ppb-1 min-1). In Chapter IV we evaluated the association between residential proximity to swine operations and childhood asthma. A metric was created to determine children's relative environmental exposure to swine CAFOs which incorporated facility size and distance and direction of the CAFO to the home. When controlling for six significant asthma risk factors, children with a larger relative environmental exposure to CAFOs had a significantly increased risk of physician-diagnosed asthma (OR=1.20, p=0.009). In stratified analysis that adjusted for a respiratory infection before the age of two years, the association between relative exposure and childhood asthma was significantly increased in children with a respiratory infection (OR=1.45, p=0.001) but not in children free from respiratory infection (OR=1.12, p=0.355).

No description available.

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It is well documented that rural and remote Australian residents have poorer access to medical services than their counterparts in capital cities. According to the Australian Institute of Health and Welfare in 1998 there were 75.3 vocationally registered general practitioners per 100,000 population in rural and remote areas, compared with 103.0 per 100,000 in metropolitan areas. In 1998 28.7% of the Australian population lived in rural and remote areas, so a substantial proportion of the Australian population is adversely affected by the unequal distribution of general practitioners. Australian country communities highly regard the services of general practitioners and they continue to demand residential medical services. Demand is driven by need for access to health services, but also by the intimate inter-relationships between the general practice and community sustainability. For example, the general practice contributes to the viability of the local hospital which is often a major employer in the district. Consequently, many country communities strive to keep their general practice by contributing to practice infrastructure, providing governance, raising funds for medical equipment, and actively helping recruitment. / thesis (PhDHealthSciences)--University of South Australia, 2004.

Remote area staff performing manual patient handling tasks in the absence of patient lifting hoists available in most health care settings are at an elevated risk of musculoskeletal injuries. The objective of this project was to identify the patient handling methods that have the lowest risk of injury. The patient handling task of lifting a patient from floor to a chair or wheelchair is a common task performed in a remote health care setting. The task was performed utilising three methods, these being: (1) heads/tails lift, (2) use of two Blue MEDesign?? slings and (3) use of a drawsheet. The task of the heads/tails lift was broken down into two distinctly separate subtasks: lifting from the (1) head and (2) tail ends of the patient load. These techniques were selected based on criteria including current practice, durability, portability, accessibility, ease of storage and cost to supply. Postural data were obtained using a Vicon 370 three - dimensional motion measurement and analysis system in the Biomechanics & Gait laboratory at the University of New South Wales. Forty reflective markers were placed on the subject to obtain the following joint angles: ankle, knee, hip, torso, shoulder, elbow, and wrist. The raw data were converted into the respective joint angles (Y, X, Z) for further analysis. The postural data was analysed using the University of Michigan???s Three-Dimensional Static Strength Prediction Program (3D SSPP) and the relative risk of injury was based on the following three values: (1) a threshold value of 3,400 N for compression force, (2) a threshold value of 500 N for shear force, and (3) population strength capability data. The effects on changes to the anthropometric data was estimated and analysed using the in-built anthropometric data contained within the 3D SSPP program for 6 separate lifter scenarios, these being male and female 5th, 50th and 95th percentiles. Changes to the patient load were estimated and analysed using the same computer software. Estimated compressive and shear forces were found to be lower with the drawsheet and tail component of the heads/tails lift in comparison to the use of the Blue MEDesign?? straps and head component of the heads/tails lift. The results obtained for the strength capability aspect of each of the lifts indicated a higher percentage of the population capable of both the drawsheet and tail end of the heads/tails lift. The relative risk of back injury for the lifters is distributed more evenly with the drawsheet lift as opposed to the heads/tails (tail) lift where risk is disproportionate with the heavier end being lifted. The use of lifter anthropometrics does not appear to be a realistic variable to base assumptions on which group of the population are capable of safely performing this task in a remote setting. This study advocates the use of the drawsheet lift in a remote setting based on the author???s experience and the biomechanical results obtained in this study. The drawsheet lift is both more accessible and provides a more acceptable risk when more than two patient handlers are involved, in comparison to the other lifts utilised lifting patients from floor to a chair.